So how, exactly, can we navigate fat-shaming from health professionals when it’s not the fat’s fault?

Why It’s Not About Health

It can be hard to fight back against doctors who are telling you that your weight is causing your health problems or vice versa. And that’s because it’s been deeply ingrained in our psyches to believe that there is a direct relationship between the two when that isn’t always the case.

What can be especially frustrating is when people – from your friends to your doctors – dismiss your assertion that fat isn’t necessarily the problem with the overzealous claim that they’re “just worried about your health.”

But here’s the thing: Fat-shaming is not about health.

It literally can’t be – because there is no valid research to indicate that body-shaming makes people healthier; if anything, raising guilt and shame in people is considered in the public health sector to have the opposite effect.

Fat-shaming is about the hatred our culture has taught us to have towards people of size. That’s it. Because if it were about health, then doctors would be treating you for the problems that you’re experiencing, not the weight that you happen to have.

The anti-fat bias in the institution of Western Medicine runs deep – and that’s a problem, considering that numerousstudies link doctors’ fatphobia to patients receiving inadequate care.

Change Your Approach

When speaking to a doctor, or when you’re going to the doctor with someone, state exactly what symptoms you are facing and what you would like to seek treatment for. In this way, you make it clear that you want a full, honest investigation of the problems that you’re having and that you won’t accept the “Lose weight” prescription as the be-all, end-all of your issue.

Deciding not to be weighed can be one helpful way to navigate this – and it’s something that people tend to forget that they can ask for! But going into the appointment not wanting your weight to be at all discussed can make your approach strong and firm.

If the nurse, doctor, or anyone asks about why you don’t want to be weighed or any other weight-related questions, you can use a response like “I did not come to discuss my weight today; I would like to focus on ________.”

If they push, repeat yourself. And if they still will not stop, tell them that you are prepared to seek out another doctor for the treatment you are wanting. Also, bringing along or being a supportive friend can help you to stick to your guns. That way, you can have someone to support you.

If you’re acting in solidarity with a loved one who is being harassed by their doctor, speak up and tell them that their behavior will not be tolerated and that you are prepared to leave and take your business elsewhere.

Shop Around for Doctors

Since a lot of doctors base their practices in weight-related health measurements, it can be difficult to find a doctor that will leave aside comments about weight and focus on other health issues you maybe having. But doing your homework to find a doctor who isn’t fatphobic can save you a lot of time and energy down the line.

Cat and Dragon is a website that has a comprehensive list of fat-friendly health professionals in every state and some countries including the UK, Canada, and Australia. Fat Friendly Docs does, too. Feel free to give this to a friend or loved one who needs to find a new doctor who is fat positive.

Also, talk to your fat friends and find out who their doctors are and if they like them. Sometimes simply talking to people that you know can help you find local practitioners who are body-positive or fat-friendly.

Educate Yourself (And Doctors!)

Learning about your health and body can be an empowering experience. It’s good to be informed! Having knowledge about our healthcare system and the reasons that fat and health have nothing to do with one another can allow you to understand some of your experiences. Also, if you feel so inclined, you can educate doctors or health professionals you may go to or have used in the past about how to be fat-friendly and practice a health-at-every-size approach in their work.

Even if you don’t feel comfortable saying something directly to them, you could always leave a voicemail or even write an e-mail explaining your experiences at their practice and giving them recommendations of books to read or link them to research to check out to back up your facts. Health at Every Size, Fat! SO?, and The Fat Studies Reader are great places to start.

And, of course, you can pass these along to your loved ones. This can actually be a great way to start a dialogue around fat and health with someone that you want to support.

Ask Them What They Need

If you have a loved one in this position, talk to them and ask them specifically what you can do to help them. It’s almost always more helpful to ask a person what their needs are rather than directly offering what you think they need.

Sometimes, it can be overwhelming to have someone who wants to get involved in your healthcare; obviously it is a very personal and private part of our lives. But simply being there to support in whatever way would be most helpful for them can be crucial in them getting the help they need.

Because no one should ever have to feel alone in the fight for fat-friendly health care.

This is a battle not only for people of size, but all of us.

Join or Start a Support Group

Being on a journey of fat acceptance can sometimes feel like a lonely one. Having a support team is critical to any type of recovery, so if you’re a person of size having a health issue, finding supporters can help you to navigate this often difficult process.

There are many Health at Every Size support groups that already exist. Usetheselists to see if any of these are a good fit for your or exist in your area. If not, consider starting one up yourself!

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Navigating a health issue while being fat (or supporting someone who is) can be a difficult journey. But realize that there is hope and that you deserve to be treated with respect by all health professionals.

One thought on “How To Support People’s Health Issues Without Fat Shaming”

1.
If a doctor recommends that a patient lose weight over a medical issue linked to excessive weight then telling the doctor “I did not come to discuss my weight today” is not only unhelpful but also technically wrong.

No doctor would claim that losing weight is the “be-all, end-all” of an issue. But when it’s a part of an issue then telling the doctor both that you want “a full, honest investigation” and that you “won’t accept” a suggestion to lose weight, is again unhelpful and somewhat dishonest.

So if a doctor insists on focusing only on health, for a problem that may very well have other causes, sure, that’s bad and should be cleared up and objected to straight away. But if it’s listed among other things, on a problem related with height or excessive body fat, then the doctor isn’t doing anything other than her/his job.

2.
“Fat-shaming is not about health. … there is no valid research to indicate that body-shaming makes people healthier”.

Well, sure. But if a doctor tells a patient that weight is related to their problem, so losing weight can improve their condition, that’s not body shaming. This is not a doctor trying to treat people by making them feel bad about their weight, it’s a doctor trying to treat people by reducing one of the possible causes for the problem.

If the doctor uses insults, focuses on weight significantly more than is warranted for the medical issue, or the likes, then that does carry it into fat/body-shaming. But nobody thinks or claims that that makes anyone healthier, doctors being abusive is accepted to be a bad thing.

3.
And of course the main point is when and if weight is actually related to other health problems or not.

And, well… Not to as much as is commonly accepted, but more than the nothing-at-all you very strongly imply. Which I claim because there are numerous studies linking weight (of some types/locations/cases) to various medical problems. And the studies that show fat being not related to medical problems, sometimes good ones, but sometimes not saying what you may think is saying.

For example I’ll use the ones explicitly linked to in this post. Well, the one from medicienenet.com you explicitly linked to a page not found, so not that one. The one from wiley.com looks like it pointed to some real article at some point but is a page not found now. And the one from nih.gov claims a server error at the moment so also hard to judge.
But there is the Time article, which while being a regular news report and not peer-reviewed study does cover and link some actual study. So from their article:

One claims that “overweight and obese people were found to be at no greater risk of developing or dying from heart disease or cancer, compared with normal weight people, as long as they were metabolically fit despite their excess weight.”

So, first, it just covers heart diseases and cancer, no other medical conditions.

But more importantly, this is for what they call “metabolically fit” people, which they define as “aside from their weight, they didn’t suffer from insulin resistance, diabetes, low levels of good cholesterol, high triglycerides and high blood pressure.”

So this doesn’t really do anything to limit the relation between overweight and heart diseases without showing that overweight isn’t related to insulin resistance or diabetes, cholesterol levels, triglycerides levels, and blood pressure. Some of which are currently considered known to be related to weight.
Essentially they say that when you look at the overweight people who don’t have many of the significant risk factors for heart disease known to be related to weight, you don’t find a relation between their weight and heart disease.
It’s a sort of a start, but not a very strong claim without a lot of supporting evidence they don’t provide.

They sort of conclude on that in the article “The finding runs counter to the prevailing wisdom that weight is in and of itself a marker of health; rather, it suggests that a person’s level of physical fitness, in addition to his or her weight, matters too.” . Which completely ignores what a “marker” or risk factor is. You’d be hard pressed to find a doctor that doesn’t think physical fitness (nitpick : not the “metabolic fitness” from the research) matters. The claim isn’t that being overweight is by itself being unhealthy, but rather that it’s a risk factor contributing to various medical conditions.

Anyway, next research the article covers: “That study found that, when it comes to your risk of early death, being obese overall may not be as important as where on the body your fat is distributed. In the study, people who were of normal weight but had a paunch — that is, a lot of visceral or belly fat, which, unlike run-of-the-mill subcutaneous fat, is known to be metabolically dangerous and to promote insulin resistance and inflammation — were twice as likely to die early as people of normal weight with no gut. People with lots of concentrated belly fat also had a higher risk of death than people who were simply obese all over.”

Which, again, doesn’t mean much without showing that having “a lot of visceral or belly fat” is completely unrelated to having extra fat.
Or, since they had comparisons also with people who are “simply obese all over” (I don’t like that terminology), what did they find comparing them to those who were “of normal weight but with no gut”?

Their link to the research paper is an access-forbidden page, but if they had this data, and it supported the overall claim that there is no relation between obesity and health, wouldn’t the Time article have mentioned it?

The next research they mention: “finding that among people already diagnosed with Type 2 diabetes, those who were obese lived longer than their thinner peers.”.

Which doesn’t surprises us with a claim that type 2 diabetes isn’t related to obesity, probably because obesity is one of the main causes/triggers for type 2 diabetes, when the body can’t produce enough insulin to cover more tissue through more blood vessels.

What we can infer is that the other causes for type 2 diabetes (cell insulin resistance? damage to the pancreas that further reduces insulin production?) has worse additional health effects (at least in terms of mortality) than obesity. “X is worse for mortality than obesity” is a far cry from saying obesity doesn’t have adverse health effects.

In another study : “researchers looked at nearly 65,000 patients with heart disease and found that overweight and obese people had the lowest risk of early death, compared with normal-weight or underweight patients; those who were underweight had the highest death risk.”

Again, it starts off with a group of people having heart diseases, and compares mortality.

So while it sounds great, the strongest claim it makes is “from the various reasons to get a heart disease, overall the ones that are not related to obesity have a higher mortality rate”. To do more it needs to show the lack of relation between obesity and heart diseases, which it doesn’t so, and doesn’t claim.

This time there was a working link to the abstract of the research paper. :
“heart disease” was “Acute Coronary Syndrome”.
Mortality was checked over 3 years (abstract doesn’t mention relation between age and BMI for the people with ACS they checked, but if there is then mortality may be lower since overweight people develop ACS sooner? I absolutely don’t know it’s true, but I also don’t know it’s not true and they don’t mention it).
The most at-risk group were the underweight one, which isn’t related to a claim about health effects of being overweight, but still indicates a possible relation between weight and health. (which you either don’t see in this study due to missing data in which case claims on overweight are similarly irrelevant, or you accept in which case you accept weight can affect health).
Also, the improvement with mortality risk for overweight people was with what they call “modest overweight”, but was reversed at about 35 BMI (severely obese).

And that’s about it for research related to this article. Nothing there “disproves the myth that being overweight is unhealthy”. It’s “if you don’t take into account many known/suspected health problems of obesity then obesity doesn’t increase your risks of dying from a few specific things” and “if you have a significant medical problem that is known/suspected to be caused by either obesity or other causes then for some such medical problems you may live longer if you got the problem due to obesity and not the other causes”.

4.
OK, wow. Sorry for being that long winded.

The problem is that while I do absolutely agree that the overall treatment in society towards fat and body weight is bad, and that body shaming does happen a lot, and that the commonly expected health dangers from overweight and obesity and probably very inflated, it is still the case (per currently best existing medical research and knowledge) that obesity is a risk factor in various medical problems.

So if you tell people that the medical problems aren’t as bad as everyone tells them it is, and if they’re overweight it’s no reason to feel bad about themselves, that’s terrific.

But this post reads more like a strong claim that any and all medical problems with obesity are false, and that it’s well proven. Which is false (as in really not supported by the evidence). And carrying this through telling people to absolutely refuse to listed to their doctors if the doctor tells them that weight may be a contributing factor to their medical problem, that can hurt people.
Fat-shaming is bad, but ignoring currently best known medical advice is a very bad overshoot in the other direction.